california
Health Care Almanac
Medicare Facts and Figures
January 2010
C A L I FOR N I A
H EALTH C ARE
F OU NDATION
Medicare Facts and Figures
Introduction
<< r e t u r n to c o n t e n t s
California has the largest number of Medicare beneficiaries of any state — 4.5 million
contents
enrollees — and as the population ages the percentage of Californians covered by
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Medicare will continue to rise. It is projected that by 2030, California’s entire elderly
Enrollment and Population. . . . . . . . . . . . . . . 7
population — those 65 and over — will be more than double what it was in 2000.
Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
This profile provides a factual framework to help consumer advocates, health care
providers, and policymakers better understand California’s Medicare population and
inform their efforts to design programs and policies that meet beneficiaries’ needs.
Spending and Utilization. . . . . . . . . . . . . . . . 18
Health Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Key findings include:
Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
• Medicare reimbursement for care delivered to California beneficiaries is higher
Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
than the national average — about $600 more per beneficiary in 2006.
• In 2004 and 2005, total annual medical payments per Medicare beneficiary
in California averaged $11,326, of which $1,330 (11 percent) came out of the
beneficiaries’ own pockets.
• A large percentage of Medicare beneficiaries suffer from multiple chronic illnesses.
In 2005, 79 percent reported having two or more chronic conditions, and 37 percent
reported four or more.
Data in this presentation are drawn from the most recent national and state-level sources
available. A full list of sources can be found on page 35.
©2010 California HealthCare Foundation
2
Medicare Facts and Figures
Projected Population, Elderly vs. Non-Elderly,
California, 2000 and 2030
Population
<< r e t u r n to c o n t e n t s
California’s elderly
population (those age
(in millions)
50000000
 Elderly (65+)
 Non-elderly (< 65)
46.5
8.3
—18%
40000000
33.9
3.6
Overview
—11%
65 and older) is expected
to more than double
between 2000 and 2030. 38.2
30000000
30.3
20000000
10000000
0
2000
2030 Projection
Source: U.S. Census Bureau, Interim State Population Projections, 2005, Table 4: Interim Projections: Change in Total Population and Population 65 and Older, by State: 2000 to 2030.
©2010 California HealthCare Foundation
3
Medicare Facts and Figures
Overview
Projected Population Growth, Elderly vs. Non-Elderly,
<< r e t u r n to c o n t e n t s
California vs. the United States, 2000 to 2030
California’s elderly
population is projected
 California
 United States
to grow much faster than
the national rate. Between
26%
2000 and 2030, the number
of Californians 65 and older
Non-elderly
(<65)
is expected to increase
19%
by 131 percent, compared
to 104 percent for the
United States as a whole.
131%
Elderly
(65+)
104%
0
20
40
60
80
100
120
140
Source: U.S. Census Bureau, Interim State Population Projections, 2005, Table 4: Interim Projections: Change in Total Population and Population 65 and Older, by State: 2000 to 2030.
©2010 California HealthCare Foundation
4
Medicare Facts and Figures
Elderly Population Growth, by Region,
California, 1990 to 2008
Overview
<< r e t u r n to c o n t e n t s
From 1990 to 2008, nearly
all of California’s regions
P e r c e n ta g e C h a n g e
experienced a significant
Total
Population
age 65+
age 85+
California Overall
23%
31%
107%
Greater Bay Area
16%
29%
101%
elderly population,
Sacramento Area
39%
54%
158%
particularly among seniors
San Joaquin Valley
37%
29%
108%
85 and older.
Inland Empire
56%
47%
157%
San Diego Area
21%
25%
120%
Los Angeles County
11%
23%
85%
Orange County
25%
55%
107%
jump in the size of their
Note: Data for all counties are provided in the Appendix.
Sources: U.S. Census Bureau, Population Estimates for Counties by Age Group (CO-99-13): July 1, 1990 and Annual Estimates of the Resident Population by Selected Age Groups and Sex for Counties:
April 1, 2000 to July 1, 2008.
©2010 California HealthCare Foundation
5
Medicare Facts and Figures
Overview
Elderly Population Growth, by County,
<< r e t u r n to c o n t e n t s
1990 to 2008
Among California counties,
the median growth rate
AGE 65 TO 84
AGE 85 AND OLDER
for people 85 and older
was 114 percent from
Growth
 Above Median
 Median and Below
1990 to 2008, compared
to 21 percent for younger
seniors.
Source: U.S. Census Bureau, Population Estimates for Counties by Age Group (CO-99-13): July 1, 1990 and Annual Estimates of the Resident Population by Selected Age Groups and Sex for Counties: April 1,
2000 to July 1, 2008.
©2010 California HealthCare Foundation
6
Medicare Facts and Figures
Enrollment and Population
Enrollment in Medicare,
<< r e t u r n to c o n t e n t s
California vs. Selected States, 2008
Population
40000000
Fifteen percent of the U.S.
population, or 44.8 million
(in millions)
 Medicare
 Non-Medicare
36.8
35000000
4.5
30000000
32.3
20000000
Medicare. While California
has the largest number of
—12%
Medicare beneficiaries in the
24.3
2.8
25000000
individuals, are enrolled in
21.5
nation at 4.5 million, they
make up a comparatively
—11%
19.5
2.9
16.6
15000000
—15%
18.3
3.2
15.1
10000000
small percentage of the
state’s total population.
—17%
12.4
2.2
—18%
10.2
5000000
0
California
Texas
New York
Florida
Pennsylvania
Sources: Mathematica Policy Research analysis of CMS State/County Market Penetration Files, July 2008; and Census Bureau State Population Estimates 2000 – 2008 (NST-EST2008-01).
©2010 California HealthCare Foundation
7
Medicare Facts and Figures
Medicare Enrollment as Percent of Population, by County,
California, 2007
Del
Norte
Siskiyou
home to higher percentages
Modoc
Shasta
Trinity
Glenn
Lake
Colusa
 <11.5% (15 counties)
 11.5% to 13% (12 counties)
 >13% to 18% (17 counties)
 >18% (14 counties)
Lassen
Tehama
Mendocino
<< r e t u r n to c o n t e n t s
California’s rural counties are
Percentage of Population Enrolled in Medicare
Humboldt
Enrollment and Population
Plumas
Butte
Yuba
Sutter
Sierra
Nevada
Placer
the state’s urban centers.
Of the approximately one
in four counties that have
Yolo
El Dorado
Alpine
SacraNapa
mento Amador
Solano
Calaveras
Marin
San
Tuolumne
Contra Costa Joaquin
San Francisco
Alameda Stanislaus Mariposa
San Mateo
Santa
Merced
Clara
Madera
Santa Cruz
Fresno
San
Benito
Sonoma
Monterey
of Medicare enrollees than
more than 18 percent of
their residents enrolled
Mono
in Medicare, most are
among the least populous
Inyo
Tulare
in the state. By contrast,
Kings
San Luis
Obispo
Santa Barbara
three of California’s five
Kern
San Bernardino
Ventura
Los Angeles
largest counties have
less than 11.5 percent of
Orange
Riverside
San Diego
Imperial
their population enrolled
in Medicare.
Sources: Medicare County Enrollment Report, 2007; U.S. Census Population Estimates, Annual Estimates of the Resident Population by Age, Sex, Race and Hispanic Origin for Counties: April 1, 2000 to July 1, 2007;
www.census.gov/popest/counties/asrh/files/cc-est2007-alldata-06.csv.
©2010 California HealthCare Foundation
8
Medicare Facts and Figures
Medicare Beneficiaries and Reimbursements, by Type,
California, 2005
Enrollment and Population
<< r e t u r n to c o n t e n t s
While the majority of
BENEFICIARIES
REIMBURSEMENTS
are eligible because of
their age, some qualify for
ESRD
1%
other reasons. In California,
14 percent are disabled.
ESRD
8%
Disabled
14%
Medicare beneficiaries
Those with end-stage renal
disease (ESRD) represent
Disabled
14%
only 1 percent of the
beneficiary population, but
account for 8 percent of
Elderly
85%
Elderly
78%
reimbursement costs.
Note: ESRD (end-stage renal disease) category comprises elderly beneficiaries with ESRD, disabled beneficiaries with ESRD, and beneficiaries with ESRD who would not otherwise be eligible for Medicare.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
9
Medicare Facts and Figures
Enrollment and Population
Medicare Beneficiaries, by Eligibility Category,*
<< r e t u r n to c o n t e n t s
California, 2000 to 2007
Population
From 2000 to 2007, the
number of Medicare
(in millions)
 Disabled
 Elderly
5000000
4000000
3000000
4.1
4.2
4.3
4.4
3.9
4.0
4.0
4.1
0.5
0.6
0.6
0.5
0.6
0.6
0.5
0.5
3.5
3.6
3.6
3.7
3.8
3.4
3.5
3.6
2000
2001
2002
2003
beneficiaries in California
increased by 12 percent.
Within that population,
disabled beneficiaries
grew at a faster rate than
elderly beneficiaries.
2000000
1000000
0
2004
2005
2006
2007
*Does not include beneficiaries with end-stage renal disease (ESRD).
Source: Annual Statistical Supplement to the Social Security Bulletin (2005 and 2008): Table 8.B3a — Hospital Insurance and/or Supplementary Medical Insurance: Number of enrollees aged 65 or older, by census
division and state or other area, Table 8.B3b — Medicare Part A (Hospital Insurance) and/or Part B (Supplementary Medical Insurance): Number of disabled enrollees, by census division and state or other area.
©2010 California HealthCare Foundation
10
Medicare Facts and Figures
Percent of Medicare Beneficiaries with Disabilities,
California vs. the United States, 2000 to 2007
Enrollment and Population
<< r e t u r n to c o n t e n t s
The percentage of California
Medicare beneficiaries
with disabilities has grown
20%
steadily over the past
17%
15%
13%
United States
California
14%
eight years. However, the
national percentage of
disabled beneficiaries has
been consistently higher
12%
than California’s over this
10%
period, and the relative
increase between 2000 and
5%
2007 has been steeper.
0%
2000
2001
2002
2003
2004
2005
2006
2007
Source: Annual Statistical Supplement to the Social Security Bulletin (2005 and 2008): Table 8.B3a — Hospital Insurance and/or Supplementary Medical Insurance: Number of enrollees aged 65 or older, by census
division and state or other area, Table 8.B3b — Medicare Part A (Hospital Insurance) and/or Part B (Supplementary Medical Insurance): Number of disabled enrollees, by census division and state or other area.
©2010 California HealthCare Foundation
11
Medicare Facts and Figures
Demographics
Medicare Beneficiary Income Distribution,
by Eligibility Category, California, 2005
100
5%
9%
80
60
9%
28%
—1%
———–3%
—1%
8%
6%
8%
—1%
11%
13%
<< r e t u r n to c o n t e n t s
Most Medicare beneficiaries
 $75,000 and Over
 $65,000 to $74,999
 $55,000 to $64,999
 $45,000 to $54,999
 $35,000 to $44,999
 $25,000 to $34,999
 $15,000 to $24,999
 Under $15,000
are of relatively modest
means, with more
than half living on an
annual income of less
than $25,000. Disabled
Medicare beneficiaries
are more likely than the
elderly to have the lowest
21%
40
of disabled beneficiaries
45%
reported an income
33%
20
incomes — 45 percent
below $15,000, compared
to 33 percent of elderly
0
Disabled
Elderly
beneficiaries.
Notes: ESRD beneficiaries are excluded unless also eligible by aged or disabled status. Figures may not add to 100 percent due to rounding.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
12
Medicare Facts and Figures
Race/Ethnicity of Elderly Medicare Beneficiaries,
California vs. the United States, 2005
Demographics
<< r e t u r n to c o n t e n t s
California’s elderly Medicare
population is more diverse
CALIFORNIA
UNITED STATES
than that of the nation, with
a higher percentage of Asian
Other
4%
Latino
2%
Asian
2%
Black
5%
Latino
6%
Other
2%
and Latino beneficiaries.
Black
8%
Asian
9%
White
76%
White
87%
Note: Beneficiaries listed as Latino may be of any race. Those in the “Other” category may include American Indian, multi-race beneficiaries, and beneficiaries of unknown race.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
13
Medicare Facts and Figures
Projection of Race/Ethnicity of Elderly Population,
California, 2000 to 2030
Demographics
<< r e t u r n to c o n t e n t s
In 2030, the elderly
population in California
2000
is projected to be more
2030 PROJECTION
diverse. As a share of the
Other
1%
Other
3%
overall population, Latinos
are expected to grow
Black
5%
to 27 percent, up from
Black
15%
Latino
13%
13 percent in 2000, while
Whites are expected to
Asian
10%
White
White
70%
50%
Latino
27%
decrease from 70 percent
to 50 percent.
Asian
5%
Notes: Beneficiaries listed as Latino may be of any race. Those in the “Other” category may include American Indian, multi-race beneficiaries, and beneficiaries of unknown race.
These data are not limited to Medicare beneficiaries. Figures may not add to 100 percent due to rounding.
Source: California Department of Finance, Population Projections by Race / Ethnicity, Gender and Age for California and Its Counties 2000 – 2050.
©2010 California HealthCare Foundation
14
Medicare Facts and Figures
Elderly Enrollee Health Coverage, by Source,
California, 2005
Coverage
<< r e t u r n to c o n t e n t s
Few of California’s Medicare
enrollees age 65 and older
depend exclusively on
traditional Medicare for
health insurance. More than
Medicare and
Employer-Sponsored
Medicare
HMO Only
26%
33%
half also rely on Medi-Cal,
Medigap, or employersponsored insurance to
help cover health costs.
Medicare and
Medigap
10%
Medicare and
Medi-Cal
Medicare
Only
9%
22%
Note: This graph represents primary coverage sources; in some cases, enrollees may have an additional source of coverage. Results exclude beneficiaries in nursing homes.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
15
Medicare Facts and Figures
Under 65 (Disabled) Enrollee Health Coverage, by Source,
California, 2005
Coverage
<< r e t u r n to c o n t e n t s
Nearly three-quarters
of disabled Medicare
enrollees under 65 rely
solely on public sources
for their health insurance,
Medicare and
Employer-Sponsored
25%
Medicare
and Medigap
2%
while slightly more than
Medicare and
Medi-Cal
44%
25 percent have some form
of private supplemental
insurance.
Medicare
HMO Only
7%
Medicare Only
22%
Note: This graph represents primary coverage sources; in some cases, enrollees may have an additional source of coverage. For adults age 18 to 64, eligibility for Medicare is tied to qualification for Social
Security Disability Insurance. Results exclude beneficiaries in nursing homes.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
16
Medicare Facts and Figures
Coverage
Medicare Advantage (MA) Enrollment,
<< r e t u r n to c o n t e n t s
California vs. the United States, 1999 to 2009
California has a higher
Percent of Beneficiaries in an MA Plan
percentage of beneficiaries
45%
enrolled in Medicare
40%
Advantage (MA) plans
39%
34%
35%
compared to the nation;
California
narrowed in recent years. As
30%
23%
25%
20%
however, this gap has
United States
17%
of 2009, the vast majority
(96 percent) of California’s
MA plans were HMOs, well
15%
above the national average
of 74 percent.
10%
5%
0%
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Note: Medicare Advantage (MA) plans are health plans that are approved by Medicare and provided by private companies. These plans combine Medicare Part A (hospitalization) and Medicare Part B (doctor’s
visit coverage) into one health plan that provides the same medically-necessary services as standard Medicare.
Source: Mathematica Policy Research analysis of CMS State/County Market Penetration files are from March of the given year(s) through 2005. For 2006 – 2007, data are from Mathematica Policy Research
analysis of CMS Monthly MA Enrollment by State/County/Contract file, November of the given year. Data on the total number of those who are eligible for Medicare from December 2005 are used to calculate
plan penetration for 2006 – 2007. For 2008 and 2009, MA enrollment data are from the July 2008 and March 2009 Monthly MA Enrollment by State/County/Contract files, and data on the total number of those
who are eligible for Medicare are from the July 2008 and March 2009 of the MA State/County Penetration files.
©2010 California HealthCare Foundation
17
Medicare Facts and Figures
Spending and Utilization
Medicare Spending,
<< r e t u r n to c o n t e n t s
United States, 1965 to 2008
Since the inception of
Spending as a Percentage of GDP
Spending (in billions)
3.5%
Medicare Part D
3.0%
Balanced Budget Act
of 1997
•
•
$500
has risen sharply across the
nation, both in total dollars
$400
2.5%
2.0%
Medicare in 1965, spending
and as a percentage of
GDP. Dramatic shifts in the
trend of Medicare spending
Omnibus Budget Reconciliation Act
of 1983
•
$300
are often associated with
legislative action, such
1.5%
$200
as the Omnibus Budget
Reconciliation Act of 1983,
1.0%
$100
the Balanced Budget Act of
1997, and the introduction
0.5%
of Medicare Part D in 2006.
0.0%
1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004
2008
$0
Note: All figures are in current dollars. Spending includes both administrative costs and reimbursement payments to health care providers.
Sources: Centers for Medicare and Medicaid Services, National Health Expenditures Historical and Projections, 1965 – 2018; Department of Commerce, Bureau of Economic Analysis, “Current-Dollar and ‘Real’ Gross
Domestic Product”.
©2010 California HealthCare Foundation
18
Medicare Facts and Figures
Spending and Utilization
Medicare vs. Private and Total Health Care Spending,
<< r e t u r n to c o n t e n t s
United States, 1965 to 2008
spending
Over the life of the program,
Medicare spending has
(in Billions)
AVERAGE ANNUAL
GROWTH RATE
$2,500
$2,000
Medicare
Private Health Care
Total Public and Private Health Care
$2,379
grown faster than private
health care spending. From
14%
9%
10%
1966 to 2008, Medicare’s
average annual percentage
increase was 14 percent
$1,500
$1,270
compared to 9 percent for
private insurance. Between
1998 and 2008, Medicare
$1,000
spending increased an
$500
$466
average of 8 percent
per year, compared to
average increases in private
$0
1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004
2008
spending of 7 percent
per year.
Note: 2008 figures are projected in source. All spending amounts are in current dollars.
Sources: Centers for Medicare and Medicaid Services, National Health Expenditures Historical and Projections, 1965 – 2018; Department of Commerce, Bureau of Economic Analysis, “Current-Dollar and ‘Real’ Gross
Domestic Product”.
©2010 California HealthCare Foundation
19
Medicare Facts and Figures
Spending and Utilization
Spending per Enrollee, Medicare vs. Private Plans,
<< r e t u r n to c o n t e n t s
United States, 1987 to 2007
Per-enrollee spending in
Medicare and private plans
$12,000
$10,422
has increased over the last
Medicare
$10,000
between 2005 and 2007,
per-beneficiary Medicare
$8,000
spending grew more than
Private Plans
$6,000
$5,968
$4,000
$2,712
twice as fast as private
spending. This acceleration
is attributable to Medicare
Part D, which added $1,175
in per-beneficiary spending
$2,000
in 2006 and $1,201 in 2007.
$1,650
$0
two decades. However,
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
Note: This chart reflects the definition of insured used by the Census Bureau’s Current Population Survey. The definition includes those covered by both employer-provided and privately-purchased plans,
whether the individual is the policyholder or covered by a family plan.
Sources: Centers for Medicare and Medicaid Services, National Health Expenditures Historical and Projections, 1965 – 2018; U.S. Census Bureau, Historical Health Insurance Tables, Table HI-1: Health Insurance
Coverage Status and Type of Coverage by Sex, Race and Hispanic Origin: 1987 to 2005; U.S. Census Bureau, Historical Health Insurance Tables, Table HIA-2: Health Insurance Coverage Status and Type of
Coverage All Persons by Age and Sex: 1999 to 2007; Sidebar: Medicare 2009 Annual Report of the Boards of Trustees.
©2010 California HealthCare Foundation
20
Medicare Facts and Figures
Annual Reimbursement per Medicare Beneficiary,
California vs. the United States, 1994 to 2006
Spending and Utilization
<< r e t u r n to c o n t e n t s
From 1994 to 2006,
California’s per-beneficiary
reimbursement exceeded
$10,000
$8,899
$8,000
California
the national figure by an
United States
average of 15 percent.
$8,304
However, the gap has
narrowed in recent years.
$5,342
$6,000
In 2006, California’s perbeneficiary reimbursement
$4,000
$4,492
was only 8 percent higher
than the national average.
$2,000
$0
1994
1996
1998
2000
2002
2004
2006
Note: The term “reimbursement” reflects payments for benefits and does not include administrative costs. The reimbursement figures on this chart do not include Medicare Part D payments.
Source: The Dartmouth Atlas of Health Care; Data Tables 1994 – 2006, Total Medicare Reimbursement
©2010 California HealthCare Foundation
21
Medicare Facts and Figures
Average Annual Medical Payments among Medicare
Beneficiaries, by Payment Source, California, 2004 and 2005
18000
◼ Private Insurance
◼ Out-of-Pocket
◼ Other Public
◼ Medicaid
◼ Medicare
$16,457
$1,916
$12,627
$2,014
$11,326
$1,667
$710
$1,542
$1,269
$656
13500
9000
$1,330
$1,163
—$355
$6,937
$2,516
0
All Beneficiaries
$6,332
Under 65
65 to 84
(disabled and/or ESRD only)
<< r e t u r n to c o n t e n t s
Medicare payments for
beneficiaries age 85 or older
are nearly 80 percent higher
than payments for those
65 to 84.
—$426
$10,220
$11,392
$1,455
$1,232
—$273
$927
$6,519
4500
Spending and Utilization
85 and Older
Notes: Data exclude beneficiaries enrolled in Medicare managed care and beneficiaries in nursing homes. Values in 2005 dollars. “Other Public” spending includes uncollected liability and payments from
Veterans Affairs and other public sources.
Sources: Medicare Current Beneficiary Survey, 2004 and 2005.
©2010 California HealthCare Foundation
22
Medicare Facts and Figures
Spending and Utilization
Medicare Spending per Enrollee, by Service Type,
<< r e t u r n to c o n t e n t s
Selected Service Types, California, 1991 to 2004
Medicare spending on
hospital and physician care
$3,807
$4,000
Hospital Care
rose at an average annual
rate of around 4 percent
$3,500
and 6 percent, respectively,
$3,000
$2,253
$2,516 Physician and
Clinical Services
$2,500
between 1991 and 2004,
while drug and nondurables spending increased
$2,000
$1,500
roughly three times as
fast (16 percent per year).
$1,251
With the introduction of
$1,000
Medicare Part D in 2006,
$500
$33
$0
$218 Drugs and
Nondurables
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
newer data will likely
show a dramatic increase
in drug spending.
Note: “Drugs and Nondurables” includes prescription drugs, non-prescription drugs, and medical sundries such as surgical and medical instruments, surgical dressing, needles, and thermometers.
Source: Centers for Medicare and Medicaid Services; National Health Expenditure Data, Health expenditures by state of residence: Medicare Summary Tables, 1991– 2004.
©2010 California HealthCare Foundation
23
Medicare Facts and Figures
Change in Prescription Drug Out-of-Pocket Spending
and Utilization Following Medicare Part D,
Results of a National Study
 Part D “Ramp-up” Period
(January 2006 to May 2006)
 Post Part D Period
(June 2006 to April 2007)
6
0
<< r e t u r n to c o n t e n t s
Medicare beneficiaries
who enrolled in Medicare
Part D made greater use
of prescribed drugs and
paid less out-of-pocket
5.9%
3
Spending and Utilization
than those who did not
participate in the program.
1.1%
As of July 2006, almost
two-thirds of California
-3
beneficiaries had enrolled,
-6
compared with about half of
– 8.8%
beneficiaries nationwide.
-9
–13.1%
-12
-15
Change in Drug Utilization
Associated with Part D
Change in Out-of-Pocket Spending on Drugs
Associated with Part D
Note: The “changes” described above represent contemporary differences between those enrolled in Medicare Part D and a non-enrolled control group.
Source: W. Yin et. al., “The Effect of the Medicare Part D Prescription Benefit on Drug Utilization and Expenditures.” Annals of Internal Medicine. February 5 2008. Vol. 148, No. 3: 169 –177.
Available at www.annals.org/cgi/reprint/148/3/169.pdf. Sidebar: U.S. Social Security Administration, Annual Statistical Supplement 2008, Table 8.B14.
©2010 California HealthCare Foundation
24
Medicare Facts and Figures
Medicare Hospital Utilization and Spending per Discharge,
California, 2003 to 2007
Inpatient Discharges
(in thousands)
(in thousands)
$14
1,000
$12
842,015
844,925
817,205
$9,883
$10,016
$10,507
$11,113
hospital discharges for
Medicare beneficiaries
decreased by an average
of about 1 percent per year,
807,665
800
$10
<< r e t u r n to c o n t e n t s
Between 2003 and 2007,
Payment per Discharge 
848,985
Spending and Utilization
while Medicare payment
per discharge rose by an
$11,414
average of nearly 4 percent
600
$8
per year. California had
the second highest
$6
400
Medicare payment per
discharge in the nation.
$4
200
$2
$0
2003
2004
2005
2006
2007
0
Note: Discharge and payment statistics do not include Medicare managed care patients.
Source: Centers for Medicare and Medicaid Services, Medicare and Medicaid Statistical Supplement, 2004 – 2008; Table 26 (2004) and Table 5.4 (2005 – 2008).
©2010 California HealthCare Foundation
25
Medicare Facts and Figures
Spending and Utilization
Service Use per 1,000 Medicare Beneficiaries,
<< r e t u r n to c o n t e n t s
California vs. the United States, 2007
California’s hospitalization
 California
800
 United States
rate for Medicare
beneficiaries is among
the lowest of all 50 states.
700
689
600
California beneficiaries
607
also use other types of
500
health care services at a
400
lower rate than the nation
as a whole.
347
300
291
200
100
0
62
Hospital Discharges
Persons Served for
Outpatient Care
73
Covered Admissions to
Skilled Nursing Facilities
75
87
Persons Served for
Home Health Care
Notes: All figures in chart are per 1,000 enrollees; figures for hospital discharges and admissions to skilled nursing facilities include only Medicare Part A enrollees. Statistics do not include Medicare enrollees in
managed care plans.
Source: Centers for Medicare and Medicaid Services, Medicare and Medicaid Statistical Supplement, 2008; Tables 5.4, 6.3, 7.3, and 10.3.
©2010 California HealthCare Foundation
26
Medicare Facts and Figures
Hospital Days and Reimbursement among Medicare
Patients at End of Life, California vs. the United States, 2005
Spending and Utilization
during the last six months of life…
California use a similar
12
10
20000
10.75
 California
 United States
70%
<< r e t u r n to c o n t e n t s
Medicare patients in
number of hospital days in
the last six months of life
as the national average.
10.81
15000
$17,349
However, spending on
hospitalizations in the
8
$13,805
6
last six months of life
is 26 percent higher in
10000
California than the nation.
4
5000
2
0
Number of
Hospital Days
0
Reimbursements for
Inpatient Hospitalizations
Source: The Dartmouth Atlas of Health Care, Data Tables, State population-based rates, 2005; Sidebar: Calfo, S., et al. “ Last Year of Life Study.” Office of the Actuary, Centers for Medicare and Medicaid Services.
©2010 California HealthCare Foundation
27
Medicare Facts and Figures
Spending and Utilization
Medicare Beneficiaries Living in Nursing Homes,
<< r e t u r n to c o n t e n t s
California vs. the United States, 2005
While a similar percentage
of Medicare beneficiaries
 California
 United States
in California and the nation
20
20%
live in nursing homes,
the use of nursing homes
varies among categories
15
of beneficiaries. Compared
14%
higher portion of California’s
10
disabled beneficiaries live
9%
in nursing homes. However,
the opposite is true among
5
5%
5%
5%
beneficiaries 85 and older.
3%
0
to the nation as a whole, a
All Beneficiaries
Disabled (Under 65)
3%
65 through 84
85 and Older
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
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Medicare Facts and Figures
Chronic Conditions among Medicare Beneficiaries,
by Eligibility Category, California, 2005
Health Status
Number of Chronic Conditions
of all Medicare beneficiaries
<< r e t u r n to c o n t e n t s
Approximately 80 percent
have two or more chronic
DISABLED
ELDERLY
health conditions.
None
2%
None
6%
One
16%
One
16%
Four or More
37%
Four or More
37%
Two
29%
Three
17%
Two
21%
Three
20%
Notes: The following were considered chronic conditions in this analysis: diabetes, cancer, heart disease, hypertension, stroke, mental disorder, Alzheimer’s disease, lung disease, arthritis, osteoporosis, and
obesity. Figures may not add to 100 percent due to rounding.
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
29
Medicare Facts and Figures
Health Status
Chronic Conditions among Medicare Beneficiaries,
by Eligibility Category, California, 2005
<< r e t u r n to c o n t e n t s
Many Medicare beneficiaries
have an array of chronic
1%
7%
Alzheimer’s Disease
illnesses. The prevalence
53%
Arthritis
of certain conditions
59%
11%
Cancer
can vary significantly by
31%
15%
Diabetes
20%
29%
Heart Disease
beneficiary category; mental
 Disabled
 Elderly
disorders and obesity are
more common among the
38%
42%
High Blood Pressure
disabled, while high blood
64%
pressure and cancer are
23%
Lung Disease
14%
more common among
72%
Mental Disorder
the elderly.
18%
37%
Obesity
19%
12%
Osteoporosis
18%
10%
11%
Stroke
0.0
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
30
Medicare Facts and Figures
Health Status
Chronic Conditions among Medicare Beneficiaries,
by Race/Ethnicity, California, 2005
<< r e t u r n to c o n t e n t s
The prevalence of chronic
conditions within the
36%
11%
13%
14%
Cancer
16%
20%607
28%
23%
Diabetes
Medicare population also
varies by race and ethnicity.
 White
 Asian
 Latino
 Black
689
High blood pressure — the most common chronic
condition across all
groups — is highest among
39%
35%
31%
38%
Heart Disease
347
Asians and Blacks and lowest
among Whites and Latinos.
Cancer prevalence is much
57%
79%
High Blood
Pressure
higher among Whites,
59%
74%
5%
Obesity
75
73
62
21%
87
largely due to a higher rate
of skin cancer.
30%
32%
0
10
Note: Beneficiaries listed as Latino may be of any race.
20
30
40
50
60
70
80
Source: Medicare Current Beneficiary Survey, 2005.
©2010 California HealthCare Foundation
31
Medicare Facts and Figures
Quality
Quality of Care, by Medicare Hospital Care Spending,
<< r e t u r n to c o n t e n t s
California vs. Other States, October 2006 to September 2007
California hospitals scored
Average Quality Score
just below the national
100%
average across 25 qualityof-care process measures
tracked by Hospital
90%
Compare, but had
United States
(state average)
significantly higher
California
Medicare payments per
80%
hospitalization across the
46 high-volume diagnoses.
70%
60%
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
AVERAGE MEDICARE PAYMENTS FOR SELECT DIAGNOSES
Notes: Hospital Compare is a public tool maintained by the US Department of Health and Human Services that tracks hospital quality of care and costs. “Average Quality Score” is calculated as the average
of state-level Hospital Compare Process of Care Measure scores (covering heart attack, heart failure, pneumonia, and surgical care); it is not limited to care received by Medicare beneficiaries. “Average
Medicare Payments for Select Diagnoses” is calculated as the average of 25th and 75th percentile Medicare spending for each Diagnosis-Related Group (DRG) averaged across 46 different high-volume DRGs.
U.S. averages are unweighted averages of state values. There is small but significant positive association between states’ average Medicare payments for common DRGs and their average score across the
25 quality of care process measures tracked by Hospital Compare (p = .014).
Source: Hospital Compare Database, August 2008 release, table HQI_STATE_MSR_AVG; Hospital Compare Database, June 2009 release, table HQI_STATE_MPV_MSR.
©2010 California HealthCare Foundation
32
Medicare Facts and Figures
Quality
Preventive Care for Medicare Beneficiaries,*
by Poverty Level, California, 2007
Colonoscopy in Last Five Years
83%
87%
79%
84%
<< r e t u r n to c o n t e n t s
 All Beneficiaries
 100% FPL
 100 –199% FPL
  200% FPL
incomes below 200 percent
of the Federal Poverty Level
are less likely than those
with higher incomes to
have had a mammogram in
the past two years or a flu
Flu Shot in Last 12 Months
shot in the last 12 months.
67%
60%
64%
70%
Conversely, colonoscopy
rates are highest for
beneficiaries with the
lowest incomes.
Mammogram in Past Two Years
78%
74%
72%
82%
0*Results include only Medicare populations
20 for whom the procedures
40 are applicable.
Medicare beneficiaries with
60
80
100
Source: California Health Interview Survey, 2007.
©2010 California HealthCare Foundation
33
Medicare Facts and Figures
Appendix
Population Growth, by County, California, 1990 to 2008
P e r c e n ta g e C h a n g e
<< r e t u r n to c o n t e n t s
P e r c e n ta g e C h a n g e
Total
Population
age 65+
age 85+
California Overall
23%
31%
107%
Alameda County
13%
18%
79%
Mendocino County
Alpine County
-4%
70%
60%
Amador County
26%
40%
Butte County
20%
Calaveras County
P e r c e n ta g e C h a n g e
Total
Population
age 65+
age 85+
Total
Population
age 65+
age 85+
25%
34%
134%
Santa Cruz County
10%
4%
45%
7%
20%
105%
Shasta County
21%
32%
134%
Merced County
37%
49%
136%
Sierra County
-2%
0%
78%
142%
Modoc County
-5%
12%
71%
Siskiyou County
2%
18%
105%
5%
120%
Mono County
27%
174%
181%
Solano County
19%
64%
200%
44%
50%
150%
Monterey County
14%
20%
85%
Sonoma County
20%
17%
101%
Colusa County
30%
19%
133%
Napa County
20%
5%
55%
Stanislaus County
36%
34%
109%
Contra Costa County
27%
41%
133%
Nevada County
23%
22%
131%
Sutter County
42%
52%
143%
Del Norte County
21%
32%
192%
Orange County
25%
55%
107%
Tehama County
23%
13%
80%
El Dorado County
37%
32%
129%
Placer County
95%
152%
289%
Trinity County
10%
98%
266%
Fresno County
35%
29%
103%
Plumas County
2%
21%
146%
Tulare County
36%
21%
96%
Glenn County
13%
-1%
36%
Riverside County
76%
56%
207%
Tuolumne County
14%
35%
177%
8%
14%
92%
Sacramento County
30%
41%
142%
Ventura County
19%
45%
125%
Imperial County
48%
58%
202%
San Benito County
49%
36%
115%
Yolo County
39%
40%
108%
Inyo County
-6%
-17%
25%
San Bernardino County
40%
36%
97%
Yuba County
25%
10%
77%
Kern County
46%
36%
124%
San Diego County
19%
23%
118%
Kings County
47%
47%
132%
San Francisco County
12%
14%
79%
Lake County
27%
-8%
87%
San Joaquin County
39%
28%
102%
Lassen County
25%
6%
82%
San Luis Obispo County
22%
24%
128%
Los Angeles County
11%
23%
85%
San Mateo County
10%
19%
103%
Madera County
67%
41%
117%
Santa Barbara County
9%
15%
81%
8%
40%
117%
Santa Clara County
18%
48%
114%
Humboldt County
Marin County
Mariposa County
Source: U.S. Census Bureau, Population Estimates for Counties by Age Group (CO-99-13): July 1, 1990 and Annual Estimates of the Resident Population by Selected Age Groups and Sex for Counties: April 1, 2000 to July 1, 2008.
©2010 California HealthCare Foundation
34
Medicare Facts and Figures
Data Sources
<< r e t u r n to c o n t e n t s
Many of the charts in this publication rely on data from a sub-sample of the 2005 Medicare Current Beneficiary Survey (MCBS)
in California. The MCBS is a stratified random sample of beneficiaries representing the entire population of aged and disabled
beneficiaries and is not necessarily representative of each state. The MCBS sample for California includes 883 residents. Where
G i v e U s Yo u r F e e d b a c k
Was the information provided in this report
of value? Are there additional kinds of
possible, results were confirmed by comparison with Census records, the California Health Interview Survey, Centers for Medicare
information or data you would like to see
and Medicaid Services (CMS), Social Security statistics, and other resources.
included in future reports of this type? Is there
other research in this subject area you would
Other sources include:
Annual Report of Boards of Trustees of the Medicare Trust Funds
www.cms.hhs.gov/reportstrustfunds/downloads/tr2009.pdf
Annual Statistical Supplement to the Social Security Bulletin
www.ssa.gov/policy/docs/statcomps/supplement
like to see? We would like to know.
U.S. Census Bureau:
• American Community Survey
www.census.gov/acs/www
•
Health Insurance
www.census.gov/hhes/www/hlthins/hlthins.html
California Health Interview Survey
www.chis.ucla.edu
•
Population Estimates
www.census.gov/popest/estimates.html
Centers for Medicare and Medicaid Services:
• Medicare & Medicaid Statistical Supplement
www.cms.hhs.gov/medicaremedicaidstatsupp/01_
overview.asp
•
Population Projections
www.census.gov/population/www/projections/
index.html
•
National Health Expenditure Data
www.cms.hhs.gov/nationalhealthexpenddata/01_
overview.asp
Authors
Andrew Hackbarth, Doctoral Fellow
Pardee RAND Graduate School
Oakland, CA 94612
Dana P. Goldman, Ph.D.
University of Southern California and RAND Corporation
Kaiser Family Foundation:
• Medicare Health and Prescription Drug Plan Tracker
healthplantracker.kff.org
Mary Vaiana, Ph.D.
RAND Corporation
Statehealthfacts.org
www.statehealthfacts.org/index.jsp
©2010 California HealthCare Foundation
f o r m o r e i n f o r m at i o n
California HealthCare Foundation
Dartmouth Atlas of Health Care
www.dartmouthatlas.org
•
Please click here
to give us your feedback.
Thank you.
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35